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2017 Nebraska Youth Range Camp Application
Please use this for to apply for the Nebraska Youth Range Camp. Students between the ages of 14 and 18 are eligible to apply. This application must be fully completed or it will not be considered. Please take time to avoid typos. If you would like to print a copy, please contact Shelly Kelly at shelly@sandhillstaskforce.org or 308-214-0065 . A health and parental consent form will be mailed after your online application is received. Applications will be accepted until May 26, 2017.
Email address *
First name *
Your answer
Last name *
Your answer
Gender *
T-shirt size (adult uni-sex size) *
Date of birth *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
County of residence *
Your answer
What Natural Resource District do you reside in? *
Please visit https://www.nrdnet.org/nrds/find-your-nrd if you need help.
Applicant phone number *
Your answer
Parent/Guardian Name(s) *
Your answer
Parent/Guardian cell phone number(s) *
Your answer
Parent/Guardian home phone number(s) *
Your answer
Student e-mail address *
Most information will be sent via email and your address will not be shared.
Your answer
Parent/Guardian e-mail address *
Most information will be sent via email and your address will not be shared.
Your answer
Name of school currently attending *
Your answer
Planned year of high school graduation *
Name of sponsoring group or agency
Your answer
Have you previously attended the Nebraska Youth Range Camp? *
If so, which years did you attend?
Your answer
List school and community activities *
Your answer
List past range activities (include school, ranch, or farm work) *
Your answer
How many range contests have you participated in? *
Your answer
List awards and honors from the last two years *
Your answer
What do you expect to gain from the Nebraska Youth Range Camp? *
Your answer
Where did you hear about the Nebraska Youth Range Camp? *
Your answer
I understand that I am required to have my parents/guardian complete the Health and Insurance Waiver (one will be emailed to the addresses provided on this application and the form can be found on our website at http://www.nesrm.org/YouthRangeCamp.html). *
I understand that full payment of $200 must be submitted to the Nebraska Youth Range Camp prior to June 1, 2017. Payment can be made on the next page with a credit card or debit card or you can mail a check to Nebraska Youth Range Camp, 30721 W North River Rd, Sutherland, NE 69165. Please contact your local NRD, 4-H Advisor, and/or FFA Advisor to find sponsorships to offset the cost. *
I understand that my application must be complete for it to be considered. You will be contacted if you are selected to attend Range Camp. *
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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